1. Field of the Invention
This invention relates generally to surgical procedures, and more particularly to an improved surgical method for eliminating a condition of deep gingival pockets and the disease associated with this condition.
2. Description of Related Art
Periodontal diseases are caused by certain types of bacteria in plaque. These bacteria create toxins which irritate the gums and result in a break down of the attachment of the gum tissues to the teeth. Over time, these toxins can destroy gum tissues, and allowing the infection to progress, can result in bone loss. There are many forms of gingival and periodontal diseases, the most common types being gingivitis and adult periodontitis. Gingivitis is the earliest stage, and affects only the gum tissue. At this stage, the disease is still reversible. If not treated, however, it may lead to a more severe condition called periodontitis. The gums, bone and other structures that support the teeth become damaged. Teeth can become loose and may have to be removed. At this stage, the disease may require more complex treatment to prevent tooth loss. With healthy gingiva (gum tissue), the teeth are firmly anchored in place. Gingivitis develops as toxins in plaque irritate the gums, making them red, tender, swollen and likely to bleed easily. Periodontitis occurs when toxins destroy the tissues that anchor the in the bone. Gums become detached from the teeth, forming pockets that fill with more plaque. Tooth roots are exposed to plaque and become susceptible to decay and sensitive to cold and touch. Advanced periodontitis is present when the teeth lose more attachment because the supporting bone is destroyed. Unless treated, the affected tooth frequently become loose and may fall out. The method of treatment of periodontal diseases depends upon the type of disease and how far the condition has progressed. The first step usually a thorough cleaning which may include scaling to remove plaque and calculus deposits beneath the gum line. The tooth roots may also be planed to smooth the root surface so that the gingiva may heal next to the teeth. Surgery may be required when deeper pockets, usually over 4 to 6 mm, are found. It is difficult for the dentist or hygienist to thoroughly remove plaque and calculus from deep pockets. Patients can seldom keep them clean and free of plaque. Allowing pockets to remain may invite infection and bone destruction. When pockets are deep and bone has been destroyed, flap surgery may be necessary to provide access to the roots of the teeth in order to thoroughly remove calculus, plaque and any diseased tissue, and to recontour the bone to a more favorable architecture. In this technique, the gum is lifted away and is then sutured back into place or into a new position that will be easier to keep clean. The prior art teaches the use of surgical debridement of the root surface and the removal of granulation tissue following the resection of the soft tissue flap. Aesthetic modifications of this approach have been reported under the title of open flap curettage, reverse bevel flap surgery, Widman flap surgery and modifications of Widman flap surgery and apically positioned flap osseous surgery, guided tissue regeneration.
Relevant prior art publications include:
White, J. M. et al, Journal of Periodontology, 1994 July, 65(7):733-5 entitled; "Current status of lasers in soft tissue dental surgery".
Israel, M. et al, JOP, 1995 March, 66(3):197-204 entitled; "Predictable regeneration of tooth-supporting tissues.
Golub, L. M. et al, Journal of Clinical Periodontology, 1995 February, 22(2):100-9 entitled; "Doxycycline inhibits neutrophil (PMN) type matrix mealloproteinases in human adult periodontitis gingiva".
Israel, M. Practical Periodontics and Aesthetic Dentistry, 1994 August, 6(60-64) entitled; "Use of the CO2 laser in soft tissue and periodontal surgery".
Gold, S. I. et al, JOCP, 1994 July, 21(6):391-6 entitled; "Pulsed laser beam effects on gingiva".
The literature is rich with technique and apparatus using lasers in dental and other medical applications. We do not find a method for the removal of the deep gingival pocket, elimination of disease and reattachment of the gingiva to the tooth surface. The present invention fulfills these needs and provides further related advantages as described in the following summary.